Rigid fixation of phalangeal and metacarpal fractures.

Rational use of rigid fixation in hand surgery requires awareness of the advantages as well as the potential pitfalls of this relatively complex method of fracture management. A rational decision also necessitates familiarity with closed techniques of internal fixation which, in most cases, provide superior alternatives for the phalanges and metacarpals. The optimal application of screws, plates, and tension-band wires to small bone fractures can be ascertained only by critical assessment of large series of cases employing these devices and comparisons with similar series using other techniques of internal fixation. Nonetheless, rigid fixation is the logical choice for treatment of unstable fractures when other methods are predictably less effective. Injuries most suitable for screw or plate fixation include displaced phalangeal condylar fractures, irreducible oblique phalangeal fractures, irreducible transverse metacarpal fractures, disabling malunions, and nonunions requiring multiple adjunctive procedures. For selective fractures, especially those with established deformity or serious joint contractures, the capacity of rigid fixation to effect immediate skeletal stability and facilitate early digital motion can considerably enhance recovery. Complications are minimized by precision--in case selection and surgical techniques.